According to a recent study conducted by the Johns Hopkins University School of Medicine, more than 40 percent of hospital websites in the U.S. publicize their use of robot-assisted or robotic surgery. While robotic surgery is in high demand from patients, there remains, however, no scientific evidence to prove that using robots for surgical procedures carries any demonstrable benefits over using real surgeons for the same surgical procedures. In fact, there are disadvantages to this type of surgery-disadvantages many hospitals, according to the evidence, fail to disclose to patients.

What is Robotic Surgery?

During robot-assisted surgery, the surgeon utilizes another "set of hands" to perform a surgical procedure. The doctor sits at a console that may be near to or even in a different room than the surgery patient. The physician uses a three-dimensional "visualizer" similar to a TV screen and, with a joystick-like device, manipulates the robot's arms.

Robotic surgeries are, seemingly, the next big thing according to Marty Makary, M.D., M.P.H. and associate professor of surgery at the
Johns Hopkins University School of Medicine. Surgeries using mechanized assistance increased 400 percent over the past four years. In particular, according to the American Urological Association, robotic surgeries were performed on more than 80 percent of prostate-removal surgeries.

Intuitive Surgical-maker of a U.S. Food and Drug Administration-approved surgical-assistance robot-as well as dozens of hospitals, tout robotic surgery as a better alternative to surgery performed without robot assistance. However, Dr. Makary and other patient-safety advocates say these claims are unsubstantiated and actually have the potential to mislead patients about their benefits.

Results of the Study

To analyze claims of robotic surgery's superiority, Dr. Makary and his team from the Johns Hopkins University School of Medicine conducted a study. They examined 400 randomly selected hospital websites from around the country with 200 or more beds. They collected data on robotic surgeries (provided on the various websites), text or images offered by the surgical-robot manufacturer, and information about the performance of the robot.

The study revealed some interesting facts:

About 41 percent of the analyzed hospital websites advertised the availability and mechanics of robotic surgery.

Over a third of the hospitals had information on robotic surgery on their websites' home pages.

Two-thirds of the websites mentioned robotic surgery within one click of the home page.

The study also found that 89 percent of the hospitals' websites included statements of robotic surgery's superiority over other conventional surgical methods. Specifically, a high percentage of hospitals analyzed claimed that there are shorter recovery periods, less pain, minimal scarring, and less blood loss with robotic surgery than with conventional surgery. Additionally, more than 30 percent of the studied websites said that robot-assisted surgery results in better cancer outcomes.

Perhaps most surprisingly, information or images provided by a robot manufacturer were used on 73 percent of the hospitals' websites, and 33 percent provided a direct link to the robot manufacturer's website.

Are Robotic Surgery Claims Misleading?

After the data was compiled and analyzed, Dr. Makary concluded that the various claims the hospitals made simply cannot be authenticated; potentially misleading cancer and other patients about the best possible medical care available.

According to Dr. Makary, "The public regards a hospital's official website as an authoritative source of medical information in the voice of a physician." Hospitals have, seemingly, delegated the duty of educating patients to device manufacturers and allowed the manufacturer to make claims not substantiated by randomized, controlled studies - the gold standard of medical evidence, he says.

For example, many hospitals assert that robot-assisted surgery causes less pain, scarring, bleeding and the time patients spend in recovery. However, these same hospitals have failed to also inform the public about the potential problems associated with this type of surgery such as the lengthy time robotic surgery takes (thereby keeping patients under anesthesia longer) and how it tends to cost more. Hospitals that ignore potential downfalls and jumping on the new-technology bandwagon are potentially putting patients at risk and opening up possible medical malpractice lawsuits.

Further, Dr. Makary indicates that hospitals that use promotional materials provided by surgical-robot manufacturers are only raising questions about whether the information is really objective.

Although some patients demand robotic surgery, currently there is no proof that this newest approach is the best approach. Rather than making health-care decisions based on whether robots are used, patients are well-advised to make decisions based on the experience and past outcomes of their surgeons.

After all, as Jim Hu, director of urologic robotic surgery at Brigham and Women's Hospital pointed out, "It is not the robot that provides the benefits, it's the surgeon."

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